No commercial use is permitted unless otherwise expressly granted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. Mapping of the spinal cord using double train stimulation allows neurophysiological distinction of CT from DC pathways during spinal cord surgery in patients with and without pre-existing spasticity. It may be an option if you suffer chronic back, leg or arm pain and have not. It helps people better manage their chronic pain and reduce their use of opioid medications. A small device, similar to a pacemaker, delivers electrical pulses to the spinal cord. The use of DCS for controlling chronic low back pain (LBP) is a non-destructive, reversible procedure, thus, it is an attractive alternative for patients who may be facing or have already experienced. Therefore, when a second stimulus train was applied 60 ms after the first, the CT-fibre interneurons had already recovered ready to generate a second response, whereas the DC interneurons were still in the refractory period. Spinal cord stimulation therapy masks pain signals before they reach the brain. Dorsal column stimulators (DCS), also known as spinal cord stimulators, are most commonly used for the management of failed back surgery syndrome. The recovery times of interneurons in the spinal cord grey matter were much shorter for the CT than those for the DC. In patients with pre-existing spasticity (45%), CT stimulation again resulted in two identical responses, whereas DC stimulation generated a second response that differed substantially from the first one. In non-spastic patients (55% of cohort) an identical second response was noted following the first CT response, but the second response was absent after DC stimulation. A double train stimulation paradigm with an intertrain interval of 60 ms was devised with recording of responses from limb muscles. Recordings were obtained from 32 consecutive patients undergoing spinal cord tumour surgery from July 2015 to March 2017. This study aims to provide a technique for intraoperative neurophysiological differentiation between CT and DC in the exposed spinal cord. Neurophysiological identification is complicated by the fact that direct stimulation of the DC may result in muscle motor responses due to the centrally activated H-reflex. Anatomical identification of the corticospinal tract (CT) and the dorsal column (DC) of the exposed spinal cord is difficult when anatomical landmarks are distorted by tumour growth.
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